Embed Size (px)
Citation preview
Incivility, Horizontal Violence, and
Bullying in Nursing
Christina Purpora, RN., Ph.D.
23rd Annual Medical-Surgical Nursing Conference
April 4, 2013
Copyright Christina Purpora 2012 All rights reserved
Objectives
1. Define incivility, horizontal violence, and bullying.
2. Develop a repertoire of responses to these behaviors.
3. Explore resources available at work to address these
behaviors.
Story
What Came Up For You?
Negative Behavior in the Workplace 1,2,4
• Non-verbal examples: ignoring a co-worker, making faces,
rolling the eyes, intimidating gestures
• Verbal examples: name calling, sarcastic remarks,
backstabbing, gossiping, yelling, screaming
• Physical examples: pushing, shoving, throwing or
slamming objects
Concepts Defined
• Incivility
• Horizontal Violence
• Bullying
Incivility1
A form of psychological harassment and emotional
aggression that violates the ideal workplace norm of
mutual respect.
Horizontal Violence2,3
Harmful behavior, via attitudes, actions, words, and other
behaviors that is directed towards us by another
colleague. Horizontal violence controls, humiliates,
denigrates or injures the dignity of another. Horizontal
violence indicates a lack of mutual respect and value for
the worth of the individual and denies another’s
fundamental human rights.
Bullying4
A situation where one or several individuals persistently
(weekly) over a period of time (6 months) perceive
themselves to be on the receiving end of negative actions
(a least two) from one or several persons, in a situation
where the target of bullying has difficulty in defending
him or herself against these actions. A one time incident
is not referred to as bullying.
What’s the impact of this behavior?
• Nurses5-8
• Nursing7,8
• Healthcare organizations9,10
• Patients11
What does the literature offer in terms of ways to
address this behavior?
• Individual level12
• Unit level13
• System level14
Lessons Learned From Being a Target:
• It’s not about you
• Benefit of the doubt
• Respond in the moment
or…maybe later
• Use humor…when it fits
• Be a mirror
• Know your resources
• Ask for help
• Find an ally…or two
• Practice responses with
an ally6
• Talk with your coworkers
about negative behavior
at work and ways to
address it in the context
of your environment
More Lessons Learned
• Look in the mirror
• Be the change
Responding to a Bully
As him or her, “Why?”15
Workplace Bullying Institute
www.workplacebullying.org
Back to the story
• What would you say to Jean?
• What would you say to Jean if you were Donna?
• What would you say to Jean and Donna?
Responding to Jean using Lessons Learned
• I am taken back right now by your reaction to my
request for help.
Using Griffin’s Cognitive Rehearsal Techniques,
Donna Responds to Jean --
• “This isn’t the time or the place. Please stop.” (p. 260)
What would you say to Donna and Jean?
References
1. Felblinger DM. Incivility and bullying in the workplace
and nurses’ shame responses. J Obstet Gynecol Neonatal
Nurs. 2008; 37(2): 234-242.
2. Freire P. Pedagogy of the oppressed. 30th anniversary
ed. New York: The Continuum International Publishing
Group; 2003, original work published 1970.
3. Blanton BA, Lybecker C, Spring NM. A horizontal
violence position statement [Internet].1998. [cited 2012
Aug 30]. Available from:
http://proactivenurse.com/index.php?option=com_conten
t&Itemid=22&id=83.
References
4.Einarsen S, Hoel H, Notelaers G. Measuring exposure to
bullying and harassment at work: Validity, factor structure
and psychometric properties of the negative acts
questionnaire-revised. Work & Stress. 2009; 23(1), 24-44.
5.Sellers KF, Millenbach L, Ward K, Scribani M. The degree
of horizontal violence in RN practicing in New York State.
J Nurs Adm. 2012; 42(10): 483-7.
6. McKenna BG, Smith NA, Poole SJ, Coverdale JH.
Horizontal violence: experiences of registered nurses in
their first year of practice. J Adv Nurs. 2003; 42(1):90-96
References
7. Rowe MM, Sherlock HS. Stress and verbal abuse in
nursing: Do burned out nurses eat their young? J Nurs
Manag. 2005; 13: 242-248.
8. Rodwell J, Demir D. Psychological consequences of
bullying for hospital and aged care nurses. Int Nurs Rev.
2012; 59(4): 539-546.
9. Johnson SL, Rea RE. Workplace bullying concerns for
nurse leaders. J Nurs Adm. 2009; 39(2): 84-90.
10. Simons S. Workplace bullying experienced by
Massachusetts registered nurses and the relationship to
intention to leave the organization. ANS Adv Nurs Sci.
2008; 31(2): E48-E59.
References
11. Purpora C, Blegen MA, Stotts NA. Hospital Staff
Registered Nurses’ Perception of Horizontal Violence,
Peer Relationships, and the Quality and Safety of Patient
Care. Submitted for publication.
12. Griffin M. Teaching cognitive rehearsal as a shield for
lateral violence: an intervention for newly licensed
nurses. J Contin Educ in Nurs. 2004; 35(6): 257-263.
13. Barrett A, Korber S, Padula C. Lessons learned from a
lateral violence and team-building intervention. Nurs
Admin Q. 2009; 33(4): 342-350.
References
14. The Joint Commission. Sentinel event alert Issue 40.
Behaviors that undermine a culture of safety [Internet].
2008 Available from: http://www.jointcommission.org
15. Namie, G. Comeback lines, Fuggedaboutem. 2012 WBI
Podcast 25. [podcast on the internet]. Workplace Bullying
Institute; 2012 [cited 2013 March 5]. Available from:
www.workplacebullying.org/category/podcast
